Transcript MDRO For Physicians - Fawcett Memorial Hospital

Preventing Multi-Drug Resistant
Organism (MDRO) Infections
For National Patient Safety Goal 07.03.01
2015
Methicillin Resistant Staphlococcus
aureus (MRSA)
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About 3-8% of the population at large is a carrier of
MRSA with no apparent ill effect.
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MRSA-colonized and infected patients readily
contaminate their environment, and healthcare
personnel coming into contact with patients or their
environment readily become contaminated.
Infect Control Hosp Epidemiol 2008;29:S62–S80 © 2008 by The Society for Healthcare Epidemiology of America.
Transmission
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MRSA can live for hours, up to days on surfaces
such as cotton and polyester (our scrubs for
instance).
It spreads most commonly on HCW’s hands.
MRSA Prevention
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Contact Precautions for patients who are infected or
colonized with MRSA.
Hand hygiene – preferably with hand sanitizer
Handouts for patients and their families are
available.
Surveillance to monitor and measure control efforts
Judicious use of antibiotics
Siegel, Jane MD, and the Healthcare Infection Control Practices Advisory Committee. Management of MultidrugResistant Organisms In Healthcare Settings, 2006
MRSA Prevention cont’d:
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We identify patients who have had
MRSA previously cultured.
Patients that are identified will be
automatically placed on Contact
Precautions and screened to
determine the need for continued
Contact Precautions.
Vancomycin Resistant Enterococcus (VRE)
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Enterococcus resides in our intestines as
normal flora. It concerns us when it develops
resistance to Vancomycin.
It has the potential to cause urinary tract
infection, bloodstream infection or surgical
site infection.
VRE Transmission:
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VRE can live for hours, up to days on
surfaces such as cotton and polyester (scrubs
and privacy curtains for instance).
It can be carried on our hands or contaminated
equipment.
1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee,
2007 Guideline for Isolation Precautions: Preventing Transmission of Ifnectious Agents in Healthcare Settings, June
2007 http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
VRE Prevention:
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Contact Precautions for patients who are
infected or colonized with VRE. Hand
hygiene – preferably with hand sanitizer
Handouts for patients and their families are
available.
Surveillance to monitor and measure control
efforts
1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for
Isolation Precautions: Preventing Transmission of Ifnectious Agents in Healthcare Settings, June 2007
http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf
VRE Prevention cont’d:
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Processes identify patients who have had VRE
previously cultured and this flags the patient on
subsequent admissions to be screened.
To screen a patient for VRE a rectal swab must be
obtained.
Judicious antibiotic use
Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance: recommendations of the
Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995;44(No. RR-12):
Clostridium difficile (C.diff):
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C.diff is a bacteria that causes the most
common infectious healthcare-associated
gastrointestinal illness.¹
1 Dubberke E, ICHE 2009 30:57-66
C. diff Associated Disease
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Usually presents with diarrhea, but may occur
without diarrhea and mimic other abdominal
syndromes.
Complications (shock, colectomy, perforation,
megacolon, death) developed in 11% with first
recurrence¹
20% may have recurrent diarrhea after resolution of
the initial episode²
C.diff Transmission:
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C. diff can form into a spore, which makes it very hardy and
difficult to kill. It can live for months in the environment.
Hands or equipment come in contact with the spores that are
then carried to the patient who becomes colonized with it in
their gut.
If the patient then is exposed to antibiotics, chemotherapy, or
gastrointestinal surgery they are at risk for developing a
C.diff infection w/ toxin production, especially older patients.
1. Carrico,Ruth PhD, RN, CIC. Guide to the Elimination of Clostridium difficile in Healthcare Settings,
Assoc. for Professionals in Inf Cont and Epidem, 2008.
Changing Epidemiology
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Recent statistics show a doubling of hospital
discharges in the U.S. w/ C.diff listed as a
diagnosis
Also increasing severity of complications and
mortality related to C.diff
1. Carrico,Ruth PhD, RN, CIC. Guide to the Elimination of Clostridium difficile in Healthcare Settings, Assoc. for Professionals in Inf Cont and
Epidem, 2008.
C. diff Prevention
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Contact Precautions for infected patients for the
duration of their admission:
Private room
Limit movement out of the patient’s room
Dedicated patient care equipment
Wear gloves when entering the patients room and a
gown if contact with the bed is anticipated
C.diff Prevention cont’d:
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Ensure cleaning and disinfection of equipment and the
environment. Bleach is currently the only FDA approved
disinfectant.
Educate patients and their families/visitors
Measure compliance of hand hygiene and isolation
precautions
Soap and water hand hygiene is most effective method
Judicious use of antibiotics
Probiotic Prevention protocol use for high risk Patients
Other MDROs
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Gram-negative bacteria to include:
Resistant Acinetobacter species
ESBLs = extended-spectrum β-lactamase
producing organism
Resistant Pseudomonas aeruginosa
CRE/KPC = Carbapenem Resistant
Enterobacteriaceae /Klebsiella pneumoniae
carbapenemase producing organism
Diagnose & Treat Infections Effectively
Target the Pathogen
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Culture the patient
Target empiric therapy to likely pathogens and
local antibiogram
Target definitive therapy to known pathogens and
antimicrobial susceptibility test results
Access the experts
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Consult ID experts for patients with serious
infections
The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings CDC Foundation with support
from Pharmacia, the Sally S. Potter Endowment Fund, and Premier
Prevent Infection
Vaccinate
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Give influenza/ pneumococcal vaccine to at risk
patients before discharge
Get the catheters out
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Use catheters only when essential
Use correct catheter
Use proper insertion & catheter-care protocols
Remove catheters when no longer essential
The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings CDC Foundation with support
from Pharmacia, the Sally S. Potter Endowment Fund, and Premier
Use Antimicrobials Wisely
Practice antimicrobial control
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Engage in local antimicrobial control efforts
Use local data
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Know your antibiogram
Know your patient population
The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings CDC Foundation with support from
Pharmacia, the Sally S. Potter Endowment Fund, and Premier
Use Antimicrobials Wisely
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Treat infection, not colonization
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Use proper antisepsis for blood and other cultures
Culture the blood, not the skin or catheter hub
Use proper methods to obtain & process all cultures
Treat pneumonia, not tracheal aspirate
Treat bacteremia, not catheter tip or hub
Treat urinary tract infection, not the catheter
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The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings CDC Foundation with support from
Pharmacia, the Sally S. Potter Endowment Fund, and Premier
Use Antimicrobials Wisely
Stop antimicrobial treatment
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When the infection is cured
When cultures are negative & infection is unlikely
When infection is not diagnosed
The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings CDC Foundation with support from
Pharmacia, the Sally S. Potter Endowment Fund, and Premier
Prevent Transmission
Isolate the pathogen
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Use standard infection control precautions
Contain infectious body fluids (Follow airborne,
droplet and contact precautions)
When in doubt consult infection control experts
Break the chain of contagion
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Stay home when you are sick
Keep your hands clean
Set the example
The Campaign to Prevent Antimicrobial Resistance in Healthcare Settings CDC Foundation with support from
Pharmacia, the Sally S. Potter Endowment Fund, and Premier
Appropriate Antimicrobial Stewardship
Optimal choice of antibiotic
 Dose
 Duration of treatment
 Control of antibiotic use
Prevents or slows the emergence of resistance
among microorganisms
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